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General NPI Number Information
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NPI Number | 1073757084
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Entity Type | Organization
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Legal Business Name | MOSCOSO S.C.
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 3845 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3810
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Country | US
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Telephone | 773-277-2087
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Fax | 773-277-9436
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Provider Business Mailing Address
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Address Line | 3845 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYLVIA MOSCOSO
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Credential |
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Telephone | 773-277-2087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036103740
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036103740
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License Number State | IL
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